| NPI | 1154483592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 10593) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 48571) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2018-10-04 |