| NPI | 1689007205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 104004) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9944) |
| 1223G0001X Dentist, General Practice (Licence: TX 34666) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2019-03-25 |