| NPI | 1790787810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D010318) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 16775) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2023-04-15 |