| NPI | 1972585107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: NV S6-194C) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 5529129-9923) |
| 1223G0001X Dentist, General Practice (Licence: UT 5529129-9921) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2025-09-22 |