| NPI | 1780786467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NE 5563) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI CSDT-32) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2019-04-30 |