| NPI | 1538486204 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D-0006566-C) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 47480) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2021-08-12 |