| NPI | 1821472705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0442000238) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 10692) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2022-07-21 |