| NPI | 1043396906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-52) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV 3723) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2023-12-01 |