| NPI | 1831188507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN TN7866) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN TN7866) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2017-09-25 |