| NPI | 1417110750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 8898) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 22336) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2022-07-21 |