| NPI | 1225692361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 10852) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12013287A) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2023-01-17 |