| NPI | 1982787438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9073) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: HI DT2262) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2009-12-07 |