| NPI | 1851412472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9621) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 9621) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2026-09-28 |