| NPI | 1841260890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC c7723) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401-008303) |
| 1223G0001X Dentist, General Practice (Licence: NY 035596-1) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2023-03-07 |