| NPI | 1992821763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: TN DS0000007646) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TN DS7646) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-10-02 |