| NPI | 1881289213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 18115) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN2000241) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401419812) | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2026-01-15 |