| NPI | 1710952080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 106265) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-06813) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2025-07-18 |