| NPI | 1588911853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11210) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 6300) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2020-12-08 |