| NPI | 1225550965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 12069) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: NC 151147) |
| Enumeration Date | 2017-07-14 |
| Last Update Date | 2024-08-08 |