| NPI | 1396808572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 10562) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10562) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2022-10-21 |