| NPI | 1558787457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 13975) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011055) |
| 1223G0001X Dentist, General Practice (Licence: CA 63342) | |
| 1223G0001X Dentist, General Practice (Licence: TX 29740) | |
| Enumeration Date | 2014-03-16 |
| Last Update Date | 2024-09-25 |