| NPI | 1467011023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 62055) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16994) |
| 1223G0001X Dentist, General Practice (Licence: DC DEN1002120) | |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2024-02-10 |