| NPI | 1093861247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN ds7033) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401007999) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2012-11-08 |