| NPI | 1033152020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MS PEDO-397-06) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3306-04) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2013-07-31 |