| NPI | 1457773384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD4219) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10994) |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2019-05-02 |