NPI | 1609893122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: LA 4323) |
Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: AR 2700) |
Enumeration Date | 2006-07-17 |
Last Update Date | 2018-01-03 |