| NPI | 1821350943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: NC 10762) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: MD 15048) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2022-07-21 |