| NPI | 1104208651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL D.0006743-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3799-15) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 6838) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0442000266) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2020-07-28 |