| NPI | 1780091132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 10487) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4003) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2024-06-05 |