| NPI | 1831198050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 6181) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 915) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2007-07-08 |