| NPI | 1700967643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 8160) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 8160) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2008-10-02 |