| NPI | 1891848610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 03940) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 0647) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2008-06-03 |