| NPI | 1740620285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: IA DDS-09479) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD 433) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2018-08-10 |