| NPI | 1588810840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D008073) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 4788760) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 4788760) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2020-08-13 |