| NPI | 1841639853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000010179) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416452) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2019-07-02 |