| NPI | 1629080171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9671) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA DS022403L) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2022-05-12 |