| NPI | 1962816025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D4582ID) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4582) |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2024-02-14 |