| NPI | 1669627881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: DC DEN1000769) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 14320) |
| Enumeration Date | 2008-12-02 |
| Last Update Date | 2019-06-12 |