| NPI | 1578660213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 1001038-15) |
| Additional Taxonomies | 122300000X Dentist (Licence: WI 1001038-15) |
| 122300000X Dentist (Licence: MD 8088) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD5248) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2022-08-23 |