| NPI | 1023265170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 7055161) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-103) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2024-01-09 |