| NPI | 1679697064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14922) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN013607) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1001274) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401414164) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 35438) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-12-16 |