| NPI | 1962597971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: TN DS007065) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: TN DS007065) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-04-14 |