| NPI | 1851570402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS036976) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS036976) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2012-11-28 |