| NPI | 1316930878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-177C) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 1875) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2019-10-16 |