| NPI | 1194827287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 11501) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 100069770A) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CO 5443) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: MT 11501) | |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2022-07-21 |