| NPI | 1841585593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-195C) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D9930) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2021-06-02 |