| NPI | 1912014523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11230) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5997015) |
| 1223G0001X Dentist, General Practice (Licence: IL 019027014) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-10-05 |