| NPI | 1063787497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11447) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO Den.00202313) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60650351) | |
| 122300000X Dentist (Licence: IL 019029333) | |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2021-06-30 |