| NPI | 1962882878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TN 9711) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9711) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-03-04 |