| NPI | 1538728878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D11635) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL14006) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-01-04 |