| NPI | 1932467875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6864-15) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: SD D0982) |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2013-05-31 |