| NPI | 1477528388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR 8315) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK D1114) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2023-07-19 |