| NPI | 1174776025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4870-PD) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D008904) |
| 1223G0001X Dentist, General Practice (Licence: OH 30.022913) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2017-12-21 |