| NPI | 1609268861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2019005272) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6969) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61520) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 106) | |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2024-05-07 |