| NPI | 1750780052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: KS 61482) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 1267) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: FL DN21749) | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2022-02-28 |