| NPI | 1831192400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 4167) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA GA 9232) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2020-02-03 |