| NPI | 1134284235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MN S14) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN012130) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2023-03-07 |