| NPI | 1124054051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ME DEN5092) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7968) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO DEN.00203359) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 9401) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 754) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-12-05 |