NPI | 1760601405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: IN 12008293A) |
Additional Taxonomies | 122300000X Dentist (Licence: AZ 7690) |
122300000X Dentist (Licence: NV 4062) | |
Enumeration Date | 2007-04-24 |
Last Update Date | 2016-09-29 |