| NPI | 1306868872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 0060) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DNES000506) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN015948) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2025-08-18 |