| NPI | 1699783753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 6190) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 6619) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-10-19 |