| NPI | 1346634813 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 4189) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4189) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2018-05-10 |