| NPI | 1629497938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN015540) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 058632-1) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2018-03-29 |