| NPI | 1518265636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MT 2439) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 2439) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2016-01-07 |