| NPI | 1841376563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10201) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401410812) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2021-03-26 |