| NPI | 1487867990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 12299) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA CA23480) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-05-08 |