| NPI | 1962723957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60273197) |
| Additional Taxonomies | 122300000X Dentist (Licence: IN 12011485A) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2012-07-16 |