| NPI | 1720241052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AZ D7908) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D9115) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2009-10-15 |