| NPI | 1992362784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2020011318) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 11283803-9921) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 4378) | |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-04-16 |