| NPI | 1437396025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D008785) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2008020514) |
| 122300000X Dentist (Licence: HI 2496) | |
| Enumeration Date | 2009-01-19 |
| Last Update Date | 2016-10-04 |