| NPI | 1326454133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 10252) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001471) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-02-28 |