| NPI | 1376074211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2017017256) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7008) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2021-11-05 |