| NPI | 1851491245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: HI CSDT 55) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00010676) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2013-08-19 |