| NPI | 1124183207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-3493-PD) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 1361) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE00009846) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-12-16 |