| NPI | 1467019976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN APPLYING) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000011064) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2020-12-11 |