| NPI | 1952667230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9947) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 5980) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2020-12-08 |