| NPI | 1548371958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 1210) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 1210) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2018-07-30 |