NPI | 1710945654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS037465) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 5256838) |
Enumeration Date | 2006-05-02 |
Last Update Date | 2014-08-21 |