| NPI | 1699750810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN 11566) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: VA 0401411986) |
| 1223G0001X Dentist General Practice (Licence: WA DE 60470752) | |
| 1223G0001X Dentist General Practice (Licence: PA DS026404L) | |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2021-06-03 |