| 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 |