| NPI | 1922238427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 6606) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8831) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2016-02-18 |