NPI | 1588048045 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA 000000000) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: DE G3-0000461) |
Enumeration Date | 2015-07-15 |
Last Update Date | 2022-07-21 |