| NPI | 1215007984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: NE 7124) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10055) |
| 122300000X Dentist (Licence: UT 361016-9921) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2024-01-11 |