| NPI | 1629497656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10692) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 4029) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: FL 22879) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2018-07-31 |