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 |