| NPI | 1689033029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL 26892) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10386) |
| Enumeration Date | 2016-02-13 |
| Last Update Date | 2022-08-11 |