| NPI | 1720518350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 136) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2024014339) |
| 122300000X Dentist (Licence: ID D-4849) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2024-05-14 |