| NPI | 1861401077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 9705) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MT 9705) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-03-07 |