| NPI | 1306451992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12022) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 105486) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2023-12-05 |