| NPI | 1659936896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 13133) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1002079-15) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2025-02-12 |