| NPI | 1801382163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0411000072) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0411000072) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2024-02-05 |