| NPI | 1962408104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PR 02131) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PR D2131) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2023-12-12 |