| NPI | 1205494127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11067) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 4050-19) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2019-06-11 |