| NPI | 1669704300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2046) |
| Additional Taxonomies | 122300000X Dentist (Licence: SD D1036) |
| 122300000X Dentist (Licence: MN 13339) | |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2017-02-07 |