| NPI | 1790857738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 324402) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MS 3244-02) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-01-11 |