| NPI | 1609133172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 20150002205) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN14581) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2015-06-19 |