| NPI | 1295184927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TX 32181) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12012476A) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-08-11 |