| NPI | 1811943616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MO 014227) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30.025235) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MI 2901021771) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-10201) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2026-02-09 |