| NPI | 1609893122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 4323) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 2700) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2018-01-03 |