| NPI | 1518165430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4050-PD) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4050) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2018-10-17 |