| NPI | 1356757611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 10685) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30245) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2019-10-03 |