| NPI | 1538454855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3592-11) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27435) |
| 122300000X Dentist (Licence: MS 3592-11) | |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2020-06-22 |