| NPI | 1750390241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000008664) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901015953) |
| 122300000X Dentist (Licence: CA 57093) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-06-30 |