| NPI | 1699857995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 014295) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MO MO14295) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2019-03-11 |