| NPI | 1063199958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0411000076) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0411000076) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2025-06-30 |