| NPI | 1568504017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61114) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NY 50045841) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2015-10-08 |