| NPI | 1588858260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AK 151) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MN D11690) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2008-07-17 |