| NPI | 1508246711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2015015174) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 10160807-9923) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2019-08-30 |