| NPI | 1174613251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NH 2605) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NH NH2605) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2019-12-28 |