| NPI | 1104208974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11245) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414857) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2022-08-16 |