| NPI | 1972600989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC DGD.2025DS) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.9455GD) |
| 122300000X Dentist (Licence: OH 17287) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 17287) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2024-11-19 |