| NPI | 1699069047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9280) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9147) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2013-07-16 |