| NPI | 1043501075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 9058) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 9085) |
| 122300000X Dentist (Licence: SC 7120) | |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2022-10-26 |