| NPI | 1124038286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MS 4329-23) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR OR5478) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2023-04-28 |