| NPI | 1750588190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9289) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 6315085-9922) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2019-06-11 |