| NPI | 1144920869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MA DN1859966) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS12352) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2024-03-08 |