| NPI | 1427250265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1238) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8377) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2021-05-05 |