| NPI | 1275828667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: DC DEN1001720) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WV 3943) |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2024-10-15 |