| NPI | 1912077876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 5296) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 5296) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2022-10-20 |