| NPI | 1376539650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 8815) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6570) |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2022-11-09 |