NPI | 1154352359 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9636) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 4789) |
1223G0001X Dentist, General Practice (Licence: NC 9442) | |
Enumeration Date | 2006-07-05 |
Last Update Date | 2020-11-12 |