| NPI | 1417015082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 8371) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TN DS8371) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-05-13 |