| NPI | 1598976623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN010360) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DNES000389) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2023-04-13 |