| NPI | 1265135974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6001963-15) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS045402) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN30057) | |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2025-09-04 |