| NPI | 1720490063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 8863) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10335) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2020-04-20 |