| NPI | 1528377546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10465) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS038468) |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2022-07-21 |