| NPI | 1265426894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9594) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 299697) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2014-03-06 |