| NPI | 1003823436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 5401) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5603-015) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2020-09-25 |