| NPI | 1285830703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60080012) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 2587) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2021-03-09 |