| NPI | 1487939435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 6217) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3611-11) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2023-01-05 |