| NPI | 1043388010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D04156) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 4156) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2022-11-22 |