| NPI | 1912496993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 16676) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 16676) |
| Enumeration Date | 2018-05-06 |
| Last Update Date | 2023-12-13 |