| NPI | 1386953958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7774052-9923) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7774052-9921) |
| 1223G0001X Dentist, General Practice (Licence: OR D10758) | |
| 1223G0001X Dentist, General Practice (Licence: ID D-4588) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2022-12-22 |