| NPI | 1215965777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TN DS5098) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 4772) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2018-12-17 |