| NPI | 1336481720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN TN9833) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: OH 30023879) |
| Enumeration Date | 2013-03-23 |
| Last Update Date | 2023-09-22 |