| NPI | 1700972395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN012737) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN012737) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401411248) | |
| 1223G0001X Dentist, General Practice (Licence: IN 12010811A) | |
| 1223G0001X Dentist, General Practice (Licence: NY 50-052728-1) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-04-08 |