NPI | 1558626929 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN015981) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60459114) |
1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10030) | |
Enumeration Date | 2012-07-11 |
Last Update Date | 2021-01-07 |