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 |