| NPI | 1780816652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-5015-PD) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7371240-9921) |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2020-02-20 |