| NPI | 1780733055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC SC8365) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401007612) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2019-03-27 |