| NPI | 1902211725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID 5219) |
| Additional Taxonomies | 122300000X Dentist (Licence: MT 7811) |
| 122300000X Dentist (Licence: MT Den-Den-Lic-7811) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-03-05 |