| NPI | 1588625842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA P-91) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 15065) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2009-05-08 |