| NPI | 1386714210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: LA 6830) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: IL 019-019995) |
| 1223G0001X Dentist General Practice (Licence: IN 12009737A) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-02-05 |