| NPI | 1699879700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D5768) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D8245) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2007-07-08 |