| NPI | 1205029824 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 00000000) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2269) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2021-10-04 |