| NPI | 1699256693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KY 10400) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 125) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2020-02-14 |