| NPI | 1376571521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 657) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WI 2954) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2022-02-05 |