| NPI | 1366679706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: DC DEN1001872) |
| Additional Taxonomies | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: DC DEN1001872) |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2022-08-10 |