| NPI | 1538315460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN DS0000009838) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: KY 8818) |
| 1223G0001X Dentist General Practice (Licence: VA 0401412183) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2019-05-03 |