| NPI | 1912421306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS0000010584) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10584) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2017-07-27 |