| NPI | 1821384751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12011930A) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS038688) |
| 122300000X Dentist (Licence: NY 056356) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2013-08-06 |