| NPI | 1801961370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DN012516) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3146) |
| 122300000X Dentist (Licence: TN DS0000007945) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2011-11-17 |