| NPI | 1649228743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10570) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN16918) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-01-14 |