| NPI | 1396230868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09634) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD D1203) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2021-02-06 |