| NPI | 1861586513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 5665) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 2163-85) |
| 1223G0001X Dentist, General Practice (Licence: TN 8976) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-04-06 |