| NPI | 1154584233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MD 12474) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC den1001474) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2025-05-10 |