| NPI | 1326012048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MN D10665) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 3902) |
| 122300000X Dentist (Licence: TN 8227) | |
| 1223G0001X Dentist, General Practice (Licence: MN D10665) | |
| 1223G0001X Dentist, General Practice (Licence: WI 3902) | |
| 1223G0001X Dentist, General Practice (Licence: TN 8227) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-07-08 |