| NPI | 1063821643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 12787368-9924) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009016) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 62192) | |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2023-12-11 |