| NPI | 1700229226 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 5965) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AK 1507) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2019-07-12 |