| NPI | 1356861298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000011200) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS041389) |
| 122300000X Dentist (Licence: GA DN122872) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2022-08-30 |