| NPI | 1386717874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8328) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 48455) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2019-08-12 |