| NPI | 1679873434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2015004756) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61352) |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2022-07-21 |