| NPI | 1588231385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AL D.007136-C1) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2021019527) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2023-08-01 |