| NPI | 1134262702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901016683) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12008568A) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2008-06-26 |