| NPI | 1932761533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: PA DS042298) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042298) |
| 122300000X Dentist (Licence: OH 30.026597) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2023-07-05 |