| NPI | 1396758264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 7013) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS7013) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2019-07-25 |