| 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 |