| NPI | 1942205059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ME 2282) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 17315) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2021-04-29 |