| NPI | 1528102027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 7085) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO 2015018392) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2018-05-01 |