| NPI | 1194189795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN DS0000010944) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 9758) |
| Enumeration Date | 2016-04-09 |
| Last Update Date | 2020-01-04 |