| NPI | 1861749251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 09125) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7030) |
| 122300000X Dentist (Licence: SD D0985) | |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2015-10-13 |