| NPI | 1952362931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN10216) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D2934) |
| 122300000X Dentist (Licence: CA 56698) | |
| 122300000X Dentist (Licence: TN DS0000004304) | |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2014-01-27 |