| NPI | 1407368707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10896) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6976) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2018-03-17 |