| NPI | 1639186562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D8184) |
| Additional Taxonomies | 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: OR MD23394) |
| 2080P0203X Pediatrics Pediatric Critical Care Medicine (Licence: OR D8184) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2010-05-27 |