| NPI | 1295048163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN015772) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN015772) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS039153) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2021-11-22 |