| NPI | 1699783431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 3973) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 3134) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |