| NPI | 1558359695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS7825) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS7825) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2013-06-17 |