| NPI | 1730619495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 9374) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD D1154) |
| 1223G0001X Dentist, General Practice (Licence: IA DDS-09435) | |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2020-07-21 |