| NPI | 1073800033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9077) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9349) |
| 122300000X Dentist (Licence: KY 9077) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2018-06-01 |