| NPI | 1770923815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS PEDO-574-19) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3689-13) |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2021-08-23 |