| NPI | 1093965626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: OK 83) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OK 6048) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2011-08-25 |