| NPI | 1376603977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ 6606) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 12086) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-08-16 |