| NPI | 1174537609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2022033495) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 3476) |
| 1223G0001X Dentist, General Practice (Licence: OK 7652) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2024-02-08 |