| NPI | 1245587476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD4375) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8115) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2021-02-16 |