| NPI | 1700085933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 19309) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 19309) |
| 1223G0001X Dentist, General Practice (Licence: WI 3010-15) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2023-04-19 |