| NPI | 1114138971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3378-06) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 4339) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-03-26 |