| NPI | 1780831024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 14877) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414979) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1001052) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2023-09-18 |