| NPI | 1659464741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2035-83) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 2035 83) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2023-03-07 |