| NPI | 1811044845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2489-89) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 2489-89) |
| 1223G0001X Dentist, General Practice (Licence: LA 5619) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2023-02-03 |