| NPI | 1750464525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO DEN 01536) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 015367) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2023-04-10 |