| NPI | 1477660025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MT 2250) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3626) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-07-20 |