| NPI | 1518307610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI DT-2543) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013022282) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2017-05-08 |