| NPI | 1932364841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN008876) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 4033) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 3168) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 0017422) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901012439) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2012-10-23 |