NPI | 1326122532 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 8811) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7100) |
Enumeration Date | 2006-10-24 |
Last Update Date | 2023-08-17 |