NPI | 1972585107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-194C) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5529129-9921) |
1223P0221X Dentist, Pediatric Dentistry (Licence: UT 5529129-9923) | |
Enumeration Date | 2005-11-15 |
Last Update Date | 2022-02-09 |