| NPI | 1346284445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AK 128735) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MO 2011012490) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2019-02-06 |