| NPI | 1629485834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 9981) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 63442) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2015-02-07 |