| NPI | 1790703940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NH 04050) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: AK 1031) |
| 122300000X Dentist (Licence: AK 1031) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-11-17 |