| NPI | 1477639334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6205-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR 8109) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2020-11-09 |