| NPI | 1972864825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: ID D-4655-PD) |
| Additional Taxonomies | 1223P0221X Dentist, Pediatric Dentistry (Licence: WY 1433) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2016-02-03 |