| NPI | 1093158875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 0231) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 150808) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2021-06-21 |