| NPI | 1043376023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MS 255590) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000065295) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |