| NPI | 1770746737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MO 2016036717) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OK 6249) |
| 1223G0001X Dentist General Practice (Licence: KS 60573) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2022-07-21 |