| NPI | 1932239084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4508) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 150549) |
| 122300000X Dentist (Licence: IN 12010859A) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2009-03-28 |