| NPI | 1447624473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12012430A) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE60813142) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2019-03-29 |