| NPI | 1316258338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AR 4468) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2010016287) |
| 122300000X Dentist (Licence: CO 10701) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2023-03-07 |