| NPI | 1801024690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2405) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID d4228) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2020-03-31 |