| NPI | 1568880581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61078) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 7058) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2014009234) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2014-04-07 |