| NPI | 1154600674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11231) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 26859) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2020-11-05 |