| NPI | 1235188012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 4002) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 30776) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2016-03-27 |