| NPI | 1356721518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2013014062) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61290) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2015-11-12 |