| NPI | 1417008210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 0279) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 7063) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2024-09-04 |