| NPI | 1770041527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS00) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9309) |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2019-03-11 |