| NPI | 1477531903 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 5859) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 016059) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2011-12-01 |