| 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 |