| NPI | 1609353564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 11251) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401416081) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0401416081) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2024-11-13 |