| NPI | 1811987258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 4854) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 2475-89) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2011-09-14 |