| NPI | 1811124969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN014425) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL 5901) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: DE G10001297) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS037848) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2019-12-26 |