| NPI | 1013082833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: KY 4537) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 2841) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2014-12-04 |