| NPI | 1306208376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12013472A) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 32741) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2020-12-08 |