| NPI | 1770739427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 7896) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 7896) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2022-07-21 |