| NPI | 1477524643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00201885) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR d8112) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2024-05-24 |