NPI | 1750082426 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: LA 7409) |
Additional Taxonomies | 122300000X Dentist (Licence: LA 7409) |
Enumeration Date | 2023-03-10 |
Last Update Date | 2025-07-28 |