| NPI | 1982626883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: GA 012472) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN DS0000008518) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2007-07-08 |