| NPI | 1538213814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS8343) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 3396) |
| 122300000X Dentist (Licence: MS 3434-07) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-08-10 |