| NPI | 1841579158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: HI DT-2457) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57772) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2019-02-21 |