| NPI | 1265840896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN122431) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8673) |
| 1223G0001X Dentist, General Practice (Licence: MS 3979-18) | |
| 122300000X Dentist (Licence: TN 04552) | |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2024-01-17 |