| NPI | 1346269743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2013000825) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010105) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-01-12 |