| NPI | 1780992784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60271600) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011538a) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2018-06-20 |