| NPI | 1891080776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK DEND1484) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30-023455) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32861) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 1484) | |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2019-11-02 |