| NPI | 1295286482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416446) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA dn1857451) |
| Enumeration Date | 2016-10-22 |
| Last Update Date | 2019-06-27 |