| NPI | 1326037623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 7763) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 14510) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2015-05-19 |