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 |