| NPI | 1093235152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 11166856-9924) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12013033A) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN LDR170180) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2022-07-07 |