| NPI | 1336127851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 7905) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 7905) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2010-09-14 |