| NPI | 1144206608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8630) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 036918) |
| 1223G0001X Dentist, General Practice (Licence: NC 6089) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2007-08-24 |