| NPI | 1023325198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 7724120) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 10251) |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2018-04-25 |