| NPI | 1851517932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA 22107) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT 2278) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2009-01-06 |