| NPI | 1598883746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8912) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI MI 012859) |
| 1223G0001X Dentist, General Practice (Licence: MI 2901012859) | |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2012-02-07 |