| NPI | 1831501444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2017017504) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901021069) |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2017-09-15 |