| NPI | 1982044160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: CO 00202911) |
| Additional Taxonomies | 122300000X Dentist (Licence: ME RES81) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: HI DT 2607) | |
| Enumeration Date | 2013-07-02 |
| Last Update Date | 2022-04-17 |