| NPI | 1861663635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ D7726) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 9838133-9923) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2023-05-04 |