| NPI | 1750494951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS00004231) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS004231) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2023-01-10 |