| NPI | 1710048384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 10349) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MS 3012-97) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2019-01-21 |