| NPI | 1598963647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: NE 6920) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA 08694) |
| 1223G0001X Dentist, General Practice (Licence: CO 9440) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2023-08-31 |