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 |