| NPI | 1104855766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7949) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1002180) |
| 1223G0001X Dentist, General Practice (Licence: MD 17323) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2022-02-15 |