| NPI | 1497738728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 76) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NM 2207) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2007-07-08 |