| NPI | 1669560090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 8622) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: NE 6421) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-09-17 |