| NPI | 1548395072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 12094) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI WI3264) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2024-03-08 |