| NPI | 1801150958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS PEDO-482-14) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3662-12) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: MS 3662-12) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2018-06-13 |