| NPI | 1144300963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 57895) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN D8218) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2009-04-15 |