| NPI | 1356424519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: HI 1318) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI 1158) |
| 122300000X Dentist (Licence: HI 1515) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |