| NPI | 1992809339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: UT 91-1452679922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 0000011034) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2024-02-20 |