| NPI | 1598399602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2022008320) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 172407) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61833) | |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2024-04-12 |