| NPI | 1720135189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IN 12010895A) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 19027055) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-11-19 |