| NPI | 1811126196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 6991-15) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MA DN1855189) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2020-02-25 |