| NPI | 1104927060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 6091) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 7047) |
| 1223P0700X Dentist, Prosthodontics (Licence: KY 6091) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TN 7047) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |