| NPI | 1962545277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 5869) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN DN 10956) |
| 1223G0001X Dentist, General Practice (Licence: FL 12010515A) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |