| NPI | 1770544876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA 013061) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA 21478) |
| 1223G0001X Dentist, General Practice (Licence: TN 8338) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2013-06-18 |