| NPI | 1487271094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13623) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VT 016.0133951) |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2024-11-09 |