| NPI | 1508085366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: SC 4364) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC DEN1000155) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2019-12-03 |