| NPI | 1881022499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: VA 0442000245) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9765) |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2015-06-18 |