| NPI | 1386620201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 09454) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IN 12007700A) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2016-11-27 |