| NPI | 1326136326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN015576) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 2634) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-06-17 |