| NPI | 1982012498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: ID D-4693-PD) |
| Additional Taxonomies | 1223P0221X Dentist Pediatric Dentistry (Licence: UT 90790579922) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2018-10-22 |