| 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 |