| NPI | 1295714996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: SC 948) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 19727) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12011756A) | |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MA 19727) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-04-06 |