| NPI | 1225325640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 9554) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 000000000000) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2024-02-14 |