| NPI | 1740346170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS0000009772) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 611195051) |
| 1223G0001X Dentist, General Practice (Licence: KY 364546814) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2021-06-24 |