| NPI | 1578676219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 2559) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD4234) |
| 1223G0001X Dentist, General Practice (Licence: CO CO7197) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2019-01-17 |