NPI | 1154306579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS3670) |
Additional Taxonomies | 122300000X Dentist (Licence: TN DS3670) |
Enumeration Date | 2005-12-08 |
Last Update Date | 2013-01-22 |