| NPI | 1962131227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 11900) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 4634) |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2022-08-08 |