| NPI | 1235578741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0442000181) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 009126) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2024-08-06 |