| NPI | 1659642312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 7003) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI HI2422) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2016-11-17 |