| 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 |