| NPI | 1801969514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7938) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 006698) |
| 1223G0001X Dentist, General Practice (Licence: FL DN8459) | |
| 1223G0001X Dentist, General Practice (Licence: LA 3302) | |
| 1223G0001X Dentist, General Practice (Licence: TN DS4098) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2013-05-29 |