| NPI | 1437598216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ 8928) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12011994A) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2016-05-06 |