| NPI | 1356746713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD5023) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 64018) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2019-07-18 |