| NPI | 1255316360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC NC 4331) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 4331) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2023-07-31 |