| NPI | 1649704867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 11504) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16837) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2024-06-12 |