| NPI | 1962672287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2425) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3990) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2015-01-20 |