| NPI | 1598073157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9812) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9512) |
| 1223G0001X Dentist General Practice (Licence: OR D9512) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2019-09-24 |