| NPI | 1861582876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 9262) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IA 08338) |
| 1223G0001X Dentist General Practice (Licence: TN DS0000009262) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-07-27 |