| NPI | 1245432004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: GA 11863) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN 7511) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2012-01-19 |