| NPI | 1538728878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11635) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DENT.DE.70116225) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2026-05-15 |