| NPI | 1023563905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D-6871-C) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL D-6871-C) |
| 1223G0001X Dentist, General Practice (Licence: TX 32255) | |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2022-07-29 |