| NPI | 1316476922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IA DDS-09422) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA DDS-09422) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 106934) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2024-02-15 |