NPI | 1205211208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ME 4441) |
Additional Taxonomies | 122300000X Dentist (Licence: ME 4441) |
Enumeration Date | 2015-07-21 |
Last Update Date | 2021-07-06 |