| NPI | 1932399284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN 19575) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011001A) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2012-04-02 |