| NPI | 1871728865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013876) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NJ 22DI02403000) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2010-04-14 |