| NPI | 1164614426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 8734) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: LA 5863) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2009-11-12 |