| NPI | 1508178898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 3976-18) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ 8386) |
| Enumeration Date | 2010-07-02 |
| Last Update Date | 2018-03-17 |