| NPI | 1871887422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: AR 95) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3817) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2021-01-18 |