| NPI | 1720235781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10289) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9259) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR D9259) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2016-07-08 |