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 |