| NPI | 1396955092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010762A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60076890) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-07-01 |