| NPI | 1366537623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 1837-79) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS OS-24-79) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |