| NPI | 1093260366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 1001454-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12012588A) |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2017-01-26 |