| NPI | 1811073885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 9259) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: PA NC9259) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2024-12-19 |