| NPI | 1740508613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 15315) |
| Additional Taxonomies | 122300000X Dentist (Licence: HI DT2403) |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2016-03-14 |