| NPI | 1831178011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3186) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 8932) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2016-08-07 |