| NPI | 1801091012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: AR 65) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3628) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2010-04-05 |