| NPI | 1689885121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN9681) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12007496) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2007-07-08 |