| NPI | 1740352335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DEFC.DF.70142969) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT DEN-DEN-LIC-28425) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DEFC.DF.70142969) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: ME 3822) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 20821) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: RI 2882) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2026-07-14 |