| NPI | 1275830242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: VA 0401005438) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS0000003626) |
| Enumeration Date | 2011-02-27 |
| Last Update Date | 2022-08-30 |