| NPI | 1972682813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: MS PEDO-382-05) |
| Additional Taxonomies | 122300000X Dentist (Licence: MS 3323-05) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2011-05-24 |