| NPI | 1770877359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1001020) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001020) |
| 122300000X Dentist (Licence: MD 14943) | |
| 1223G0001X Dentist, General Practice (Licence: MD 14943) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2021-06-11 |