| NPI | 1457342826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 10608) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 5942957-9921) |
| 122300000X Dentist (Licence: IN 12011362A) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2022-03-03 |