| NPI | 1457381584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9978) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 24838) |
| 122300000X Dentist (Licence: LA 5114) | |
| 122300000X Dentist (Licence: WA DE00008151) | |
| 122300000X Dentist (Licence: OR D8219) | |
| 122300000X Dentist (Licence: TX 19322) | |
| 122300000X Dentist (Licence: CA 65197) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-05-19 |