| NPI | 1831454917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO DEN.00202697) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: WA DE60749021) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2019-07-12 |