| NPI | 1871807172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 89) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6252) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2026-02-18 |