| NPI | 1457308660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401411636) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 470900865) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2023-03-07 |