| NPI | 1023260791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NH 4211) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 57807) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2020-09-17 |