| NPI | 1194777854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7563) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 6858) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-09-11 |