| NPI | 1831224294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR D2464) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: FL M662-423-73-146-0) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2022-07-21 |