| NPI | 1740391465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: NV S4-113C) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: FL DN4783) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-04-10 |