| NPI | 1821401852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 11342) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC DGD.8369 GD) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2020-12-22 |