| NPI | 1144606690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10459) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10459) |
| Enumeration Date | 2015-08-07 |
| Last Update Date | 2017-03-17 |