| NPI | 1831328202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN014560) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DN1855398) |
| 1223G0001X Dentist, General Practice (Licence: MA DL10638) | |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2021-11-03 |