| NPI | 1942380480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 2795-94) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC 5359) |
| 1223G0001X Dentist, General Practice (Licence: MD 9599) | |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2012-08-30 |