| NPI | 1225185515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 7040) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12009862A) |
| 122300000X Dentist (Licence: KY 7040) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2008-02-14 |