| NPI | 1720197403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: IN 8174) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: KY 3853) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2008-05-27 |