| NPI | 1871686402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014895) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010874A) |
| 1223G0001X Dentist, General Practice (Licence: KY 8447) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-10-21 |