| NPI | 1871707315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 009153) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 54949) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2016-07-26 |