| NPI | 1174937270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID d-5149-pd) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR d10877) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 188794) | |
| 122300000X Dentist (Licence: KY 9438) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-05-10 |