| NPI | 1255420337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 248589) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-10-25 |