| NPI | 1730793118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AZ D010742) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D010742) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2024-10-29 |