| NPI | 1861470924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE00010051) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 14445) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 56536) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2009-04-30 |