| NPI | 1235426834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL 6351) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6200) |
| Enumeration Date | 2011-07-02 |
| Last Update Date | 2018-11-06 |