| NPI | 1366757718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9213) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 6918) |
| Enumeration Date | 2010-08-10 |
| Last Update Date | 2021-01-13 |