| NPI | 1992933725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60244473) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA ma) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2018-08-15 |