| NPI | 1629636097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7535) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT DEN-DEN-LIC-19245) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2022-01-07 |