| NPI | 1821389800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: DC DEN1001662) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 15870) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401-412801) | |
| 1223G0001X Dentist, General Practice (Licence: PA DS-024916-L) | |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2020-02-19 |