| NPI | 1518499573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1002219) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401417281) |
| 1223G0001X Dentist, General Practice (Licence: FL 23162) | |
| 1223G0001X Dentist, General Practice (Licence: CT 12126) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-01-21 |