| NPI | 1174577811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 009319) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 8803) |
| 122300000X Dentist (Licence: VA 0401412410) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2009-03-31 |