| NPI | 1871661900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN 8600) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN013067) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2008-12-16 |