| NPI | 1386807220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC DGD 7082) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011137A) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2011-10-25 |