| NPI | 1477645737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD1200) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD1200) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2019-11-11 |