| NPI | 1386752061 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 07221) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 7221) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 7221) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 6460) | |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2025-02-13 |