| NPI | 1851829162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OR D11423) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 10508) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2022-07-21 |