| NPI | 1518375690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 10082) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12013020A) |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2018-08-01 |