| NPI | 1730593765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA 09179) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008972) |
| 122300000X Dentist (Licence: IA 09179) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2019-10-01 |