| NPI | 1831148519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 56727555-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 56727559921) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2022-04-13 |