| NPI | 1235342510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE000113196) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D9044) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-03-07 |