| NPI | 1750884938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 4653) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 104706) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2023-07-13 |