| NPI | 1770590580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 10630) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401008369) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN5115) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 54492) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2014-11-19 |