| NPI | 1992923338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 9402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3280-03) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2024-05-02 |