| NPI | 1861556276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 7258) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: LA 5026) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2007-07-08 |