| NPI | 1063856912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4412) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2012019405) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2021-10-04 |