| NPI | 1306335468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA xxxxxxxxxxxxx) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16860) |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2020-09-27 |