| NPI | 1831291236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN 0000011511) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 3572) |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2021-05-04 |