| NPI | 1043625338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00202458) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012086A) |
| 122300000X Dentist (Licence: IL 0190229818) | |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2016-06-09 |