| NPI | 1629181482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 4401) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC 2135) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2019-01-02 |