| NPI | 1477710390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TX 24155) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS037152) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2024-11-05 |