| NPI | 1174638266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401410748) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC DEN1001823) |
| 1223G0001X Dentist General Practice (Licence: CA DDS62796) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-11-02 |