| NPI | 1336125442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: HI DT-2275) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 53341) |
| 1223G0001X Dentist, General Practice (Licence: PA DS030250L) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2008-06-02 |