| NPI | 1558665281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: PA ds041062) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ME 2511) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2021-03-15 |