NPI | 1235200049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2021041645) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 5279193-9922) |
Enumeration Date | 2006-11-13 |
Last Update Date | 2024-02-26 |