| NPI | 1548573702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-127C) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL10984) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS039104) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4560-PD) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2022-06-22 |