| NPI | 1407595317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 18519) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401418252) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401418252) | |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2025-05-19 |