| NPI | 1427026376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2008035694) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DD2639) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2020-05-27 |