| NPI | 1538327606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NM DD1206) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM NM 1206) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2019-07-03 |