| NPI | 1104931534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DNO 12611) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS9424) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2012-08-31 |