| NPI | 1497249783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11189) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 34249) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2021-04-06 |