| NPI | 1780726810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN3922) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 7842) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401006276) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |