| NPI | 1720308935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: MT 4064) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 58924) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2018-03-17 |