| NPI | 1518018258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12011718A) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8107) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2011-09-02 |