| NPI | 1346595576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT DEN-DEN-LIC-7748) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD LL633) |
| 122300000X Dentist (Licence: MD LL674) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2017-06-07 |