| NPI | 1053571927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: TN 8817) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 39286) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2011-04-19 |