| NPI | 1235580937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9695) |
| Additional Taxonomies | 122300000X Dentist (Licence: WV 4227) |
| 1223G0001X Dentist, General Practice (Licence: KY 10188) | |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2022-01-26 |