| NPI | 1588976641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 9178) |
| Additional Taxonomies | 1223D0001X Dentist Dental Public Health (Licence: TN 9178) |
| Enumeration Date | 2010-07-06 |
| Last Update Date | 2010-11-18 |