| NPI | 1407984495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: UT 141816-9921) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AK 1214) |
| 1223G0001X Dentist General Practice (Licence: OR 9178) | |
| 1223G0001X Dentist General Practice (Licence: NV 1059) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2024-10-10 |