| NPI | 1295077428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9829) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414566) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2021-07-07 |