| NPI | 1043585730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11325) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD5055) |
| Enumeration Date | 2012-03-14 |
| Last Update Date | 2023-07-11 |