| NPI | 1033404157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 29468) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT-2527) |
| 122300000X Dentist (Licence: CA 60617) | |
| 122300000X Dentist (Licence: NY 055713) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2014-05-22 |