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 |