| NPI | 1447743653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 11279) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 10114) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2023-10-27 |