| NPI | 1548371768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11740) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN122564) |
| 122300000X Dentist (Licence: NY 047009) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-11-20 |