| NPI | 1609919083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 8397) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DNO13441) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2016-12-21 |