| NPI | 1962585398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: IN 12009098A) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 19016199) |
| Enumeration Date | 2006-10-21 |
| Last Update Date | 2007-07-08 |