| NPI | 1215956628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 8172) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14422) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-10-24 |