| NPI | 1306834049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-07997) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 124456) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2025-04-30 |