| NPI | 1194923334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2245) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MT 2245) |
| 122300000X Dentist (Licence: MT 2245) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2013-06-10 |