| NPI | 1912450297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2372) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: MT 2161) |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2019-07-05 |