| NPI | 1568585594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR FC3623053) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D9563) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-07-21 |