| NPI | 1063503126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS MS2183-85) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 2181-85) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-09-06 |