| NPI | 1215038732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC NC11044) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL 9460) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-12-02 |