| NPI | 1770999658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MD 15899) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MA DN1857888) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: VA 0401414840) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: PA DS042769) | |
| 1223P0221X Dentist Pediatric Dentistry (Licence: TX 30191) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2023-06-08 |