| NPI | 1376078493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: DC DEN1002090) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: VA 0401416883) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: MI 2901022319) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2024-02-26 |