| NPI | 1356408173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4564) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 51649) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2022-09-02 |