| NPI | 1457806457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 10387670-9923) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID 4774) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2022-07-21 |