| NPI | 1720655772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SD D1348) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7705) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7705) | |
| Enumeration Date | 2021-06-08 |
| Last Update Date | 2023-08-04 |