NPI | 1609106012 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4483-PD) |
Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: UT 8147013-9923) |
Enumeration Date | 2010-01-07 |
Last Update Date | 2024-03-26 |