| NPI | 1073809133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 940) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 7129) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9343) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2022-07-21 |