| NPI | 1942397609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 2912) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN DS002912) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2010-11-01 |