| NPI | 1689298606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MD 17144) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD EXEMPT1) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2024-03-13 |