| NPI | 1720499122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: SC DGD 8357) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: SC DGD 8357) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2016-10-24 |