| NPI | 1790076594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: SC 914) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC 6988) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2023-12-05 |