| NPI | 1972660454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401007304) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA 019702) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2014-04-15 |