| NPI | 1477714426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D008151) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 4823179-9921) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2023-02-20 |