| NPI | 1376550111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK DEND1462) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 4818089-9922) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2025-02-27 |