| NPI | 1831832443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2024002921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 62224) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2024-10-03 |