| NPI | 1972816288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2023019325) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8296939-9923) |
| 122300000X Dentist (Licence: NV 6004) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2023-06-01 |