| NPI | 1689687881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 8768) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN MN8922) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2011-06-30 |