| NPI | 1326333477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CT 010584) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 10584) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2018-07-04 |