| NPI | 1811490337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 6001081) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-09728) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16474) | |
| Enumeration Date | 2018-03-11 |
| Last Update Date | 2023-10-08 |