NPI | 1669729588 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 11892) |
Additional Taxonomies | 122300000X Dentist (Licence: MS 3659-12) |
122300000X Dentist (Licence: KS 61218) | |
1223P0221X Dentist, Pediatric Dentistry (Licence: KS 61218) | |
Enumeration Date | 2012-08-09 |
Last Update Date | 2023-09-28 |