| NPI | 1528492824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6633) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6046-C1) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2019-02-25 |