| NPI | 1881825032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D9960) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9660) |
| 122300000X Dentist (Licence: AK DEN D 1310) | |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2024-07-31 |