| 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 |