| NPI | 1053350694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DNF000308) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DNCS000195) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2023-04-13 |