| NPI | 1801200134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MS 3755-14) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AL 6099-C1) |
| Enumeration Date | 2014-06-14 |
| Last Update Date | 2015-02-26 |