| NPI | 1720341100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 3684-13) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN DS0000010429) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2018-03-17 |