| NPI | 1992153167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AL D.0006730) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 3440) |
| Enumeration Date | 2016-05-28 |
| Last Update Date | 2024-07-25 |