| NPI | 1497198246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 26013) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WY 1376) |
| Enumeration Date | 2013-04-11 |
| Last Update Date | 2024-08-22 |