| NPI | 1457703290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV s6-166) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11915) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2024-08-19 |