| NPI | 1811130164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: TN 9392) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8592) |
| 122300000X Dentist (Licence: TN 9392) | |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2013-05-17 |