| NPI | 1811992027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 3674) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 2267) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 5384) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2016-10-03 |