| NPI | 1740275593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2005019770) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 8613) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN29949) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2026-05-22 |