| NPI | 1962678276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA dn123552) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 00203058) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 600203415) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2026-08-06 |