| NPI | 1558486282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12008665A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019015150) |
| 122300000X Dentist (Licence: OR 05128) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |