| NPI | 1902038656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: TN 9601) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 9601) |
| 1223G0001X Dentist, General Practice (Licence: NV 5969) | |
| 1223G0001X Dentist, General Practice (Licence: WA DE60159812) | |
| Enumeration Date | 2009-08-13 |
| Last Update Date | 2020-12-03 |