| NPI | 1497948772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3433-07) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 343307) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2019-11-08 |