| NPI | 1316151475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 3102-99) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS PEDO-369-03) |
| 122300000X Dentist (Licence: MS 3102-99) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2023-05-02 |