| NPI | 1063588788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: MS 200583) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: MS 11986) |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2007-07-08 |