| NPI | 1285860189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1001229) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14495) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2024-04-13 |