| NPI | 1730293549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MI 2901019234) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI CSDT-38) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2010-05-15 |