| NPI | 1144468414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 12338) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 25132) |
| Enumeration Date | 2009-01-26 |
| Last Update Date | 2023-10-02 |