| NPI | 1487769303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 369873) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 4584) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2024-03-04 |