| NPI | 1205831633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3362) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NY 060784) |
| 122300000X Dentist (Licence: GA DN013833) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2019-09-23 |