| NPI | 1265761498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS3271) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 003271) |
| Enumeration Date | 2009-12-17 |
| Last Update Date | 2022-12-05 |