| NPI | 1457804718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 10732) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9842) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2018-08-16 |