| NPI | 1023145430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 389916) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY KY4598) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2019-03-05 |