| NPI | 1750403135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: SC 4051) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN 17876) |
| 122300000X Dentist (Licence: MA 21510) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2024-02-05 |