| NPI | 1699906255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401413260) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0442000107) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2013-05-20 |