| NPI | 1851693048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000009226) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN009951) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2019-09-17 |