| NPI | 1629226576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 9011) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN18161) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2024-07-31 |