| NPI | 1700147345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 4256-21) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: LA 6302) |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2024-06-18 |