| NPI | 1669801569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1001335) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15625) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2021-08-26 |