| NPI | 1033897517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2025016688) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2025016688) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7912) | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-07-22 |