| NPI | 1972550630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 30755) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IN 12010415) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2015-05-22 |