| NPI | 1598220618 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12013049A) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AZ d011622) |
| Enumeration Date | 2019-02-02 |
| Last Update Date | 2022-11-15 |