| NPI | 1194113373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 24580) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 6160) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 6160) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL dn24580) | |
| Enumeration Date | 2014-12-22 |
| Last Update Date | 2025-05-07 |