| NPI | 1386993525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AR 3883) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 7406) |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2021-09-16 |