| NPI | 1194714014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 7946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000007946) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2023-04-21 |