| NPI | 1467945402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 10981) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE60857594) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2019-06-24 |