| NPI | 1821224577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ND 2227) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7356970-9922) |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2021-06-25 |