| NPI | 1659710218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-09044) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV LL-348-13) |
| 122300000X Dentist (Licence: IA DDS-09044) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2016-03-07 |