| NPI | 1043247257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA Dn011911) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN011911) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2024-07-12 |