| NPI | 1992822811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AK 924) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: AK 101) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2014-01-14 |