| NPI | 1023172814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 56917) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010925A) |
| 1223G0001X Dentist, General Practice (Licence: IL 019026459) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-02-20 |