| NPI | 1053622670 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 3552-10) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3552-10) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2018-05-07 |