| NPI | 1164894044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10288) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 1316) |
| 122300000X Dentist (Licence: TN 10288) | |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2023-09-29 |