| NPI | 1235287012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD3989) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 1843) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2023-07-11 |