| NPI | 1548273212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS 5135) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: GA 14567) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2015-05-20 |