| NPI | 1386044469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8852) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9849) |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2020-12-21 |