| NPI | 1982835831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 9201) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 8844) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2021-02-04 |