| NPI | 1538422472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12012277A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019.029009) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2016-02-24 |