| NPI | 1639466824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D008634) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 995) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2013-06-18 |