| NPI | 1265684161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7113006-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7113006) |
| 1223G0001X Dentist, General Practice (Licence: UT 7113006-8903) | |
| Enumeration Date | 2008-10-22 |
| Last Update Date | 2023-12-20 |