| NPI | 1427154418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO CO7055) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10524) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2022-01-26 |