| NPI | 1245438233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8643) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 150627) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2024-03-07 |