| NPI | 1790338168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 2021020458) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30025875) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61920) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2022-11-01 |