| NPI | 1225264054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011708) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855074) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2012-10-12 |