| NPI | 1891753067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: NE 5878) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 22875) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2011-10-05 |