| NPI | 1598735268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 6167) |
| Additional Taxonomies | 122300000X Dentist (Licence: AR 2857) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-03-07 |