| NPI | 1548335433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 7957) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 12010912A) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2014-02-24 |