| NPI | 1548498207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 13035) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 11654) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2022-02-08 |