| NPI | 1629457767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: VA 0401414581) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: DC DEN1001447) |
| Enumeration Date | 2015-05-21 |
| Last Update Date | 2015-05-21 |