| NPI | 1366004186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 11887) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6979) |
| 122300000X Dentist (Licence: AL D.0006670-C1) | |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2022-07-07 |