| NPI | 1326348046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6665-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9158504) |
| Enumeration Date | 2010-10-27 |
| Last Update Date | 2020-01-16 |