| NPI | 1568089076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM DD5597) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV LL-541-20) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2023-10-02 |