| NPI | 1942243639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: AR 4296) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MO 2016004154) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2022-04-02 |