| NPI | 1386050474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11841) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11224) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2020-07-08 |