| NPI | 1255560520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014301) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 10471) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2021-02-10 |