| NPI | 1417053646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA DN011225) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS6972) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2014-06-18 |