| NPI | 1417963406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901018856) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9190) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-10-28 |