| NPI | 1033771597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR 3441) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 51251) |
| 1223G0001X Dentist, General Practice (Licence: NC 11703) | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-12-29 |