| NPI | 1891718557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411742) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WV 2994) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-03-18 |