| NPI | 1376766261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 202099) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI CSDT-11) |
| 1223G0001X Dentist, General Practice (Licence: MA 16236) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2015-08-13 |