| NPI | 1225284433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3439-07) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000008594) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2014-06-19 |