| NPI | 1932729480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS043165) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN122993) |
| 282NC2000X General Acute Care Hospital, Children | |
| Enumeration Date | 2020-04-23 |
| Last Update Date | 2023-04-26 |