| NPI | 1831327873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4666-PD) |
| Additional Taxonomies | 122300000X Dentist (Licence: AK 117778) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2018-01-30 |