| NPI | 1710972898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 10471) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 3693) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2026-06-26 |