| NPI | 1225489859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 11651) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 2.011651) |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2021-06-04 |