| NPI | 1427178011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WI 6115) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MN D11712) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-12-05 |