| NPI | 1144439308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2407) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10265) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2021-01-05 |