| NPI | 1508356221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2024020973) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 62279) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2025-01-13 |