| NPI | 1265686836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8895) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 8895) |
| 1223G0001X Dentist, General Practice (Licence: MS 3487-08) | |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2024-04-15 |