| NPI | 1417052903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS-0000005134) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 5134) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2022-11-10 |