| NPI | 1982734075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MD 13834) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 13834) |
| 122300000X Dentist (Licence: DC DEN1000572) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2021-12-01 |