| NPI | 1750763074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00203148) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8663) |
| 122300000X Dentist (Licence: IN 12012308A) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2018-02-26 |