| NPI | 1053507418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 8687) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011068A) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2010-05-26 |