| NPI | 1407002496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 377590-9922) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NV 4758) |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2022-11-14 |