| NPI | 1053554725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-5576-PD) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60607943) |
| 122300000X Dentist (Licence: CA 58096) | |
| 122300000X Dentist (Licence: AZ 7807) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2024-04-16 |