| NPI | 1497897854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 1698-75) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 4878) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2019-11-13 |