| NPI | 1508831371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10022) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 3418) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2023-04-27 |