| NPI | 1720088917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 8556) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 8556) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2019-07-01 |