| NPI | 1740274661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901022954) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 5438-015) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IL 019024428) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2021-09-02 |