| NPI | 1407937287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 2424-88) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MS 2424-88) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2019-08-14 |