| NPI | 1740263029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 6806) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NE 4721) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2004025887) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2007-07-09 |