| NPI | 1326328527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9345) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN DS000009345) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2016-05-24 |