| NPI | 1104209501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7237) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7237) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 1482) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2022-07-21 |