| NPI | 1831677244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WI 100189815) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 4345) |
| Enumeration Date | 2018-07-30 |
| Last Update Date | 2019-11-06 |