| NPI | 1538276597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 14947) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 3235) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2016-03-30 |