| NPI | 1609186576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MO 2007034336) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 1991) |
| 122300000X Dentist (Licence: TN 1935) | |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2010-10-13 |