| NPI | 1679099543 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS043580) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD LL851) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MD LL851) | |
| Enumeration Date | 2017-08-22 |
| Last Update Date | 2022-11-25 |