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 |