| NPI | 1093911513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 60502) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 2589) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2018-08-23 |