NPI | 1386752061 |
---|---|
Entity Type | Individual |
Gender | Male |
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) | |
Enumeration Date | 2006-08-25 |
Last Update Date | 2023-07-28 |