| NPI | 1265059091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 12772511-9922) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 7421) |
| 1223G0001X Dentist General Practice (Licence: NV LL-538-20) | |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2022-06-28 |